This project proposes to examine and improve the processes by which older women receive a Papanicolaou (Pap) smear test for cervical cancer during hospital stays in the state of Maryland. Screening for the early detection of cervical cancer is vital for older women, who bear a high mortality from this essentially preventable cancer. Hospital admissions represent an opportunity for screening these women, who are unlikely to use obstetrician gynecologists or family planning clinics. Maryland law requires all hospitalized women to be offered a Pap test; however, older, low income and chronically ill women do not appear to receive hospital screening. Variation among hospital policy and physician attitudes and practices necessitates evaluation of organizational and behavioral factors in each hospital if legislation is to improve screening. The objectives of the project are to gather information on organizational and behavioral factors influencing the screening of older women for cervical cancer during hospital stays, and to provide specific recommendations to hospitals and cancer control agencies for improving hospital screening rates. Its purpose is to improve screening for older women within existing patterns of health care utilization, rather than by persuading older women to seek additional care for cervical screening. All hospitals in Maryland will be contacted in order to evaluate each hospital's approach to screening female admissions for cervical cancer. Organizational and policy characteristics of each hospital will be examined, as well as information on how a Pap test is done in each hospital - who orders them, who performs them, and what, if any, reminder system exists. Next, using computerized discharge data will be used to determine hospital-specific admissions patterns for older women (volume, reason for admission, type of physician, service area, length of stay). Using these two data sources, a sample of Maryland hospitals, and physicians within these hospitals, will be developed, providing a representative selection of care settings with regard to older women patients, and organizational characteristics influencing Pap testing. Providers within hospitals will be selected by medical specialty, rank, age and volume of older patients. Sampled physicians will be asked to complete a mailed survey interview, which will measure knowledge, attitudes, and practices related to screening elderly women for cervical cancer. Physician and hospital data will be analyzed together to identify organizational barriers related to attitudes and practices associated with poor screening rates.